Massachusetts Home Care Providers Brace For Added Costs Under New State Oversight  

Massachusetts’ new licensing framework for non-medical home care agencies will come with financial trade-offs for providers.  

The new law will, starting Nov. 4, require providers to implement mandatory caregiver training, background checks and heightened administrative oversight. These requirements will likely increase overhead and operating costs for home care agencies, but they are essential to establish baseline safety standards and protect vulnerable older adults, industry leaders told Home Health Care News.

“Every single agency operating now in the state will have to follow the same standard, and it’s going to become very transparent if they’re not,” Lorena Silva, former CEO of Vitra Health, told HHCN.

Silva served as Vitra’s CEO for almost four years before transitioning this month to serve as an executive advisor.

Braintree, Massachusetts-based Vitra Health provides financial, community and other kinds of support for caregivers, as well as adult foster programs. Before joining Vitra Health, Silva also served as the executive director of the board of nursing for the Massachusetts Department of Public Health.

An Act to Improve Massachusetts Home Care makes several notable changes to home care operations in the state of Massachusetts.

First, it requires home care companies to conduct background checks on all employees. It also mandates that agencies implement training on worker safety, abuse prevention and quality care and maintain workers’ compensation and liability insurance.  

In addition, the law requires home care providers to meet worker safety and consumer protection standards, as well as state-mandated operational, financial and ownership disclosures.

The law aims to prevent abuse and improve consumer protections when accepting non-medical home care services, such as assistance with eating, toileting, dressing, bathing and other acts of daily living.

“Massachusetts families deserve peace of mind when they hire someone to care for their loved ones at home,” Massachusetts Governor Maura Healey said in a statement upon signing the bill into law. “This law strengthens the safety, quality and accountability of home care across Massachusetts, giving families confidence in the care their loved ones receive and supporting the dedicated workers who make independent living possible.” 

Following the law going into effect, temporary licensure will be due by May 3, 2027 and permanent licenses due by Nov. 4, 2027.

What will change, what will not

Home care providers should begin to prepare for the regulatory changes and assess how the licensing requirements would affect their existing practices, said Angelo Spinola, home health, home care and hospice chair at Polsinelli Law Firm.

“Given the act’s broad definition of a ‘home care agency,’ licensing requirements may extend beyond traditional home care providers to include certain referral, registry and matching arrangements,” Spinola said. “It will affect not only new ‘home care agencies’ but providers who have been operating historically in Massachusetts that meet the definition.” 

Based in Kansas City, Missouri, Polsinelli Law Firm specializes in healthcare, including home health and hospice, as well as finance, technology, real estate and other practice areas.

Silva said the new law would establish a common baseline and benefit agencies that already maintain strong safeguards. For instance, the annual training that the state will require for home care workers includes topics on dementia, abuse and neglect, infection control, falls and emergencies.

“What that does is pretty much level the playing field for all agencies,” Silva said. 

Beyond caregivers, anyone holding at least a 5% ownership stake in the home care agency will need a background check. In addition, they would have to disclose information about what other companies they hold ownership in as well as civil and criminal findings.

However, the new legislation will come with some costs for Massachusetts-based home care providers.

Home care agencies will have to fund more oversight, training and administrative capacity through regulatory requirements. However, those mandates could cut into profit margins, said Renee McInnes, CEO of Croí Health.   

The added costs raised concerns about whether some agencies could remain viable while continuing to pay staff competitively, McInnes said. Adhering to the new regulations could eat into the company’s ability to maintain their organization and compensate staff well. This could be especially true for private pay providers whose margins are limited by how much a consumer is willing to pay.

Norwell, Massachusetts-based Croí Health provides home care, home health, hospice and palliative care, as well as other services, across 27 communities surrounding Boston’s South Shore.

“You have to have educators because there’s required dementia training every year, so you have to add all those resources in,” McInnes said. “It’s not a bad thing, but it is going to cut into the profitability.”

Recordkeeping and other administrative infrastructure requirements also raise concerns. Standalone non-medical home care agencies may have to add more organizational infrastructure to comply with the new law, McInnes said.  

Despite the costs for providers, An Act to Improve Massachusetts Home Care ultimately protects consumers and helps ensure vulnerable patients receive quality care, McInnes said.

“Licensing is necessary. Oversight is necessary,” McInnes said. “There’s another layer of protection for the for the patients, and I think that was our biggest concern.”